Macmillan Lymphoedema Clinical Nurse Specialist

I am what you would call, the ‘new generation’ of Macmillan nurses! I treat those who develop lymphoedema as a result of their cancer therapies.

Lymphoedema? What is that? Well, it isn’t too complicated… I promise!

Although onset can be initially unexpected and traumatic (mainly because those who develop lymphoedema think the cancer has recurred) with reassurance, people understand this is not the case!However (and I apologise for getting technical) to help you understand, I feel I need to include the educational bit…

Definition of lymphoedema:The human body contains two vital circulatory systems – the blood vessel system and the lymphatic system. The lymphatic vessels, although very rarely recognised by the medical profession, are larger and more numerous than blood vessels and are filled with white fluid known as lymph. This lymph fluid contains a collection of cells called lymphocytes that help the body to fight against infections. Alongside fighting infections, the lymphatic system also helps the body rid itself of unwanted waste and fluid, in the same way a drainage system takes dirty water away from our homes. When each cell in the body functions, it uses energy and produces waste. These waste materials are collected into the lymph capillaries which are the end point of the lymphatic system situated in areas surrounding the cells. From then on with the help of the muscles, fluid is moved through the series of valves in the lymphatic vessels towards the nearest set of lymph nodes. These lymph nodes are small glands that act as filters, filtering out the waste products and breaking them down. From there, the fluid and broken down waste products are then able to enter the blood vessel system, where they are removed from the body.Lymphoedema is a chronic swelling of a part of the body, due primarily to waste fluid failing to drain through the lymphatic system correctly. It can be caused by a genetic lymphatic abnormality or from damage to parts of the lymphatic system caused by a whole variety of things, including infection, trauma, tumours, surgery or radiotherapy. Often there is a delay between the damage to the system and the swelling, for example, lymphoedema of the arm can occur some years after breast cancer treatment. Lymphoedema occurs most commonly in the arms or legs, but can also affect the head and neck, trunk or genital area. Lymphoedema is chronic and incurable but can be very easily managed with appropriate treatments.

Early signs that lymphoedema is developing: • The limb becomes heavier, starts to ache and noticeably increased in size (puffiness)• The limb can feel warmer than an area not affected • If the arm is affected there is often an increase in wrist size, so cuffs or a watch feels tight. At times the fingers and upper hand can feels swollen and tight• If the legs are affected, the lower legs are often more vulnerable to becoming swollen, so the elastic at top of the sock may start to mark the skin. Visible swelling can also be seen at the top of the foot• Lymphoedema can occur after someone has suffered from cellulitis – a skin infection that has rapid onset and requires antibiotics.

Treatment:Well, unlike many treatments, this relies on the individual being active and exercising!• Walking briskly with added body movement is ideal, but even if you decide to try to walk up and down your staircase, round the block or to the corner shop it all helps. Try to build the intensity and the distance up over time, the main message is be consistent.• Jogging • Some may choose to join a gym/health club; aerobics sessions are particularly beneficial.• Swimming or aqua-aerobics – the water pressure enhances the ability of the muscles to pump, in turn increasing the drainage of the lymphatic system• Cycling• Golf• Tennis or any racket sport• Tai chi & yogaIf you do indulge in any other sport, it`s the action of the muscle pump, that enhances lymph drainage! So if this is incorporated into your sport… it helps.

Exercises when followed in relation to lymphoedema prevention or management have one goal: to enhance the muscle pumps that support lymphatic vessels to pump congested areas of fluid to areas where it can drain more easily, thereby reducing the swelling

Compression stockings:These are a favourite!!Oh dear…I hear a sigh “Nooo … not Nora Batty stockings!”Things have changed and compression stockings have become sexy!We now have French and German ones, of most colours and patterns.Don’t be put off thinking they are too horrible to wear as they really have improved visually and make a difference to lymphoedema!

Skin care:I know it sounds like a relatively simple measure, but taking good care of your skin is absolutely vital in preventing lymphoedema. Avoiding and treating any injury to the skin surface prevents the development of an infection known as CELLULITIS, which in some instances eventually leads to lymphoedema. Good skin care centres on considering what you do during your day, your hobbies, home life and work, and taking simple precautions when carrying out activities associated with them. The aim is to keep your skin supple and its surface intact to prevent any external bacteria breaking through the skin and causing the above infection.

The dreaded Do’s and Don’ts...Avoid knocks, scratches from pets and breaking the skin as much as possible If you do suffer from a cut or abrasion ensure immediate first aid is carried out – apply anti-septic cream to the area and cover with a plaster. If undergoing medical treatment please ensure health care professionals do not use the affected arm or leg when taking blood or monitoring blood pressure.Keep the affected lymphoedema arm or leg spotless, and dry thoroughly, but be gentle when drying to avoid abrasions.Make sure under clothes are washed regularly, in detergents likely to not cause sensitivity.Moisturise the skin daily. If possible, use a cream that contains few preservatives, this will reduce the likelihood of you becoming allergic to it. Avoid sunburn and try to prevent insect bites whilst on holiday or in hot weather – use appropriate SPF sun cream and insect repellent before exposure.Whilst in car or sitting in direct sunlight ensure that the affected limb is coveredBe careful when cutting toe and fingers nails – do not cut cuticles. A chiropodist may be required to help you wit this. If shaving, it’s best to use an electric razor. Be aware that some hair removal creams can cause sensitivities causing you to inadvertently scratch.If your hobbies include sewing always use a thimble to avoid the finger being punctured with a needle.Those of you who garden should wear gardening gloves (if your arm is affected) and appropriate foot wear (if your legs are affected)If lymphoedema is present in the legs ensure conditions such as athletes foot, verrucas or blisters are treated immediately and thoroughly. If persistent inform your GP or District Nurse.It is important that you wear the right fitting, sturdy shoes and clean socks or tights.Ensure you perform regular inspections of your skin surface and do not neglect areas of redness or heat. If other symptoms such as extreme tiredness, headache, nausea and/or temperature (flu-like symptoms) also occur you must seek advice from your GP immediately. This may be cellulitis and is quite easily treated with antibiotics

It`s my role to support you and help advise ways to improve the effects of lymphoedema or better yet, prevent the onset!

Please don’t suffer in silence and seek the advice of your lymphoedema nurse if you are at all concerned.